Migraines & Headaches Community

Which medications work for migraine prevention? This question comes up all the time, so I've made a list of some of the medications we use for headache prevention, along with a little information about the medication.

The dose is important, so your doctor has to be familiar with both the "normal" dose and the maximum dose. (A dose that is too small may not work, even if you take it for a long time)


Propranolol--this is a "betablocker" type of blood pressure medication. Atenolol and nadolol are similar medications

Verapamil--this is a "calcium channel blocker" type of blood pressure medication. We usually prescribe the 24 hour long lasting capsules, but it comes in a less expensive immediate release version.

Divalproex Sodium--This is the generic name for one of the common medications used for migraine prevention (you can look up the brand name). It is pretty important to be on the 24 hour extended release tablets of this one, because the side effects are much less common with the extended release version.

Topiramate--This is the generic name for a common medication used for migraine prevention. Many people like this because it can cause modest weight loss in 1/5 people who take it. It also causes tingling in the hands in more than 50% of people who take it. It is important to start at a small dose and go up slowly to avoid side effects

Nortriptyline (and Amitriptyline)--These older medications can work at relatively low doses for migraine prevention. They were originally used to treat depression, but at much higher doses than we use for headache prevention

Trazodone--This is another older medication originally used for depression. It is pretty sedating, and can really help patients who have trouble sleeping and frequent headaches.

Gabapentin--This is helpful for some headache patients, but usually a 2nd or 3rd choice medication for headaches. Because it is also used for fibromyalgia, back pain and neuropathy pain, some patients may take it for more than one problem. Doses up to 3600 mg/day are "normal". It has no medication interactions, so is safe with other medications.

Pregabalin--this is the generic name of a medication that has been advertised heavily for diabetic peripheral neuropathy. It can help with headaches. It is often used with other medications haven't worked.

Zonisamide--This is a generic medication that is used to treat epilepsy (like Topiramate, Divalproex, Gabapentin, and Pregabalin). It can cause weight loss and tingling like Topiramate, but is less likely to cause memory problems. If you are allergic to Sulfa mediations, you cannot take it.

Levetiracetam--This is the generic version of a medication used to treat epilepsy. Its sometimes used for people with chronic daily headaches.

Tizanidine--This muscle relaxer is sometime used for headache prevention, usually in patients with chronic daily headaches, or tension headaches.